Wrinkling Test: Difference between revisions

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== Purpose<br>  ==
== Purpose<br>  ==


Wrinkle or Wrinkling or Shivel test  is a [[Special|special test]] for hands. Wrinkle test is used to check the nerve integrity of the hand by assessing the proper nervous response to an environmental stimulus which is water immersion for sustained period of time. Wrinkle test is used to diagnose a nerve injury or a limb's digit denervation.  
Wrinkle or Wrinkling or Shivel test  is a [[Special|special test]] for hands.The Wrinkle test is used to check the nerve integrity of the hand by assessing the proper nervous response to an environmental stimulus which is water immersion for a sustained period of time. A Wrinkle test is used to diagnose a nerve injury or a limb's digit denervation.  


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== Technique<br>  ==
== Technique<br>  ==


* Patient should be in sitting position  
* The patient should be in a sitting position
* Take warm water in a bowel  
* Take warm water in a bowel
* Immerse patients affected or testing hand in the bucket
* Immerse patients affected or testing hand in the bucket
* Keep it immersed for around 10-30 minutes[[File:Negative sign for wrinkle test.jpg|thumb|Negative sign on test. <ref>Image by Nicole Hanusek, 2007, [https://www.flickr.com/photos/nhanusek/473806277/in/photostream/ Mike's wrinkly hands], Flickr, [Assessed on 26, November, 2022]</ref>]]
* Keep it immersed for around 10-30 minutes[[File:Negative sign for wrinkle test.jpg|thumb|Negative sign on test. <ref>Image by Nicole Hanusek, 2007, [https://www.flickr.com/photos/nhanusek/473806277/in/photostream/ Mike's wrinkly hands], Flickr, [Assessed on 26, November, 2022]</ref>]]
* Take the hand out and look for wrinkles in hand
* Take the hand out and look for wrinkles in hand
* A positive sign is not having wrinkle in any digit of the hand and negative sign is having wrinkles on finger as shown in figure.
* A positive sign is not having wrinkles in any hand digit and a negative sign is having wrinkles on the finger as shown in the figure.


== Evidence  ==
== Evidence  ==


In a study conducted by Rubin et al they mention that wrinkle test have a sensitivity of 69.5%, specificity of 62.5% with a confidence interval of 95% in diagnosing the digital nerve injury.<ref>Rubin G, Orbach H, Rinat B, Shay R, Rozen N. [https://journals.lww.com/annalsplasticsurgery/Fulltext/2020/01000/The_Utility_of_Diagnostic_Tests_for_Digital_Nerve.12.aspx?casa_token=P85C22KHwb0AAAAA:0BRyzt7P-X7wlPJF5zwTXBOY8P29BByuQ-wdT8eKazb9M0QJtEymXQ3vunxMNZQnbwZn4ZwiLF4S6eQiWEn03A The utility of diagnostic tests for digital nerve injury]. Annals of Plastic Surgery. 2020 Jan 1;84(1):73-5.</ref>   
In a study conducted by Rubin et al, they mention that wrinkle tests have a sensitivity of 69.5%, a specificity of 62.5% with a confidence interval of 95% in diagnosing the digital nerve injury.<ref>Rubin G, Orbach H, Rinat B, Shay R, Rozen N. [https://journals.lww.com/annalsplasticsurgery/Fulltext/2020/01000/The_Utility_of_Diagnostic_Tests_for_Digital_Nerve.12.aspx?casa_token=P85C22KHwb0AAAAA:0BRyzt7P-X7wlPJF5zwTXBOY8P29BByuQ-wdT8eKazb9M0QJtEymXQ3vunxMNZQnbwZn4ZwiLF4S6eQiWEn03A The utility of diagnostic tests for digital nerve injury]. Annals of Plastic Surgery. 2020 Jan 1;84(1):73-5.</ref>   


The journal of hand therapy explains the significance that it is quite helpful to denervation in an infant or a young child who have not yet developed enough skill to be able to understand the instructions of other examination. Wrinkle test do not require much cognitive understanding.<ref>Packham T, Ahmad A, Huxtable M, Jacob N, Schutten D, Gjertsen D, DeMatteo C, MacDermid JC, Bain J. [https://www.jhandtherapy.org/article/S0894-1130(19)30294-7/fulltext Skin Temperature Asymmetry and Stimulated Skin Wrinkling: Reliability and Validity for Evaluating Obstetrical Brachial Plexus Injuries.] Journal of Hand Therapy. 2019 Oct 1;32(4):550.</ref>   
The journal of hand therapy explains the significance that it is quite helpful to denervation in an infant or a young child who has not yet developed enough skills to be able to understand the instructions of other examinations. Wrinkle test do not require much cognitive understanding.<ref>Packham T, Ahmad A, Huxtable M, Jacob N, Schutten D, Gjertsen D, DeMatteo C, MacDermid JC, Bain J. [https://www.jhandtherapy.org/article/S0894-1130(19)30294-7/fulltext Skin Temperature Asymmetry and Stimulated Skin Wrinkling: Reliability and Validity for Evaluating Obstetrical Brachial Plexus Injuries.] Journal of Hand Therapy. 2019 Oct 1;32(4):550.</ref>   


A research conducted by Kava et al University of Texas at Austin stated that wrinkle test is used to investigate the [https://www.physio-pedia.com/Sympathetic_Nervous_System?utm_source=physiopedia&utm_medium=search&utm_campaign=ongoing_internal sympathetic nervous system] integrity of the hand. <ref>Kava JL. [https://repositories.lib.utexas.edu/handle/2152/89199 Water immersion skin wrinkling: modulatory influences of age, sex, body mass index,] ''and physical activity status'' (Doctoral dissertation).</ref>   
Research conducted by Kava et al University of Texas at Austin stated that the wrinkle test used to investigate the [https://www.physio-pedia.com/Sympathetic_Nervous_System?utm_source=physiopedia&utm_medium=search&utm_campaign=ongoing_internal sympathetic nervous system] integrity of the hand. <ref>Kava JL. [https://repositories.lib.utexas.edu/handle/2152/89199 Water immersion skin wrinkling: modulatory influences of age, sex, body mass index,] ''and physical activity status'' (Doctoral dissertation).</ref>   


== Resources  ==
== Resources  ==


There are many videos demonstrating the wrinkling test are available on web from which this video exactly demonstrates how to do the test and clearly shows positive and negative sign of the test.
Many videos demonstrate the wrinkling test available on the internet, from which this video exactly shows how to do the special test and clearly show positive and negative signs of the tests.  
{{#ev:youtube|GIuVr9OgT_M}}<ref>Dr thomas McClellan In the Clinic: Fingertip Skin Wrinkling in Water and Digital Denervation Available from: https://www.youtube.com/watch?v=GIuVr9OgT_M </ref>
{{#ev:youtube|GIuVr9OgT_M}}<ref>Dr thomas McClellan In the Clinic: Fingertip Skin Wrinkling in Water and Digital Denervation Available from: https://www.youtube.com/watch?v=GIuVr9OgT_M </ref>


Revision as of 16:04, 26 November 2022

Original Editor - Ehtisham Panhwar
Top Contributors - Ehtisham Panhwar and Kirenga Bamurange Liliane

Purpose
[edit | edit source]

Wrinkle or Wrinkling or Shivel test is a special test for hands.The Wrinkle test is used to check the nerve integrity of the hand by assessing the proper nervous response to an environmental stimulus which is water immersion for a sustained period of time. A Wrinkle test is used to diagnose a nerve injury or a limb's digit denervation.


Technique
[edit | edit source]

  • The patient should be in a sitting position
  • Take warm water in a bowel
  • Immerse patients affected or testing hand in the bucket
  • Keep it immersed for around 10-30 minutes
    Negative sign on test. [1]
  • Take the hand out and look for wrinkles in hand
  • A positive sign is not having wrinkles in any hand digit and a negative sign is having wrinkles on the finger as shown in the figure.

Evidence[edit | edit source]

In a study conducted by Rubin et al, they mention that wrinkle tests have a sensitivity of 69.5%, a specificity of 62.5% with a confidence interval of 95% in diagnosing the digital nerve injury.[2]

The journal of hand therapy explains the significance that it is quite helpful to denervation in an infant or a young child who has not yet developed enough skills to be able to understand the instructions of other examinations. Wrinkle test do not require much cognitive understanding.[3]

Research conducted by Kava et al University of Texas at Austin stated that the wrinkle test used to investigate the sympathetic nervous system integrity of the hand. [4]

Resources[edit | edit source]

Many videos demonstrate the wrinkling test available on the internet, from which this video exactly shows how to do the special test and clearly show positive and negative signs of the tests.

[5]

References[edit | edit source]

  1. ↑ Image by Nicole Hanusek, 2007, Mike's wrinkly hands, Flickr, [Assessed on 26, November, 2022]
  2. ↑ Rubin G, Orbach H, Rinat B, Shay R, Rozen N. The utility of diagnostic tests for digital nerve injury. Annals of Plastic Surgery. 2020 Jan 1;84(1):73-5.
  3. ↑ Packham T, Ahmad A, Huxtable M, Jacob N, Schutten D, Gjertsen D, DeMatteo C, MacDermid JC, Bain J. Skin Temperature Asymmetry and Stimulated Skin Wrinkling: Reliability and Validity for Evaluating Obstetrical Brachial Plexus Injuries. Journal of Hand Therapy. 2019 Oct 1;32(4):550.
  4. ↑ Kava JL. Water immersion skin wrinkling: modulatory influences of age, sex, body mass index, and physical activity status (Doctoral dissertation).
  5. ↑ Dr thomas McClellan In the Clinic: Fingertip Skin Wrinkling in Water and Digital Denervation Available from: https://www.youtube.com/watch?v=GIuVr9OgT_M
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